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General NPI Number Information
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NPI Number | 1467139550
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Entity Type | Organization
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Legal Business Name | MIND THEORY THERAPY, PLLC
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 5900 BALCONES DR STE 4000
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 832-500-3236
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR STE 4000
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 832-500-3236
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, LEAD PSYCHOTHERAPIST
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Name | LARICA LYNN URBINA
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Credential | LPC
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Telephone | 405-602-9899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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